Red Blood Cell Transfusion in the Intensive Care Unit
Authors: Senta Jorinde Raasveld, Sanne de Bruin, Merijn C. Reuland, Claudia van den Oord, Jimmy Schenk, Cécile Aubron, Jan Bakker, Maurizio Cecconi, Aarne Feldheiser, Jens Meier, Marcella C. A. Müller, Thomas W. L. Scheeren, Zoe McQuilten, Andrew Flint, Tarikul Hamid, Michaël Piagnerelli, Tina Tomić Mahečić, Jan Benes, Lene Russell, Hernan Aguirre-Bermeo, Konstantina Triantafyllopoulou, Vasiliki Chantziara, Mohan Gurjar, Sheila Nainan Myatra, Vincenzo Pota, Muhammed Elhadi, Ryszard Gawda, Mafalda Mourisco, Marcus Lance, Vojislava Neskovic, Matej Podbregar, Juan V. Llau, Manual Quintana-Diaz, Maria Cronhjort, Carmen A. Pfortmueller, Nihan Yapici, Nathan D. Nielsen, Akshay Shah, Harm-Jan de Grooth, Alexander P. J. Vlaar, Alisa Higgins, Ary Serpa Neto, Karina Brady, Erica Wood, Alexis Poole, Tony Trapani, Meredith Young, Jamie Cooper, Paul Secombe, Graham Reece, Prashanti Marella, David Brewster, Alan Rashid, Ruwan Suwandarathne, Raman Azad, Jonathan Barrett, Elisha Turner, Amber-Louise Poulter, Lixian Chen, Vishwanath Biradar, Christina Whitehead, Sandra Peake, Alexis Tabah, Stephanie O'Connor, Michael Reade, Guido Janssen, Richard McAllister, Katherine Triplett, David Bowen, Hergen Buscher, John Santamaria, Dinesh Parmar, Paul Power, Craig French, Matthew Mac Partlin, Md Motiul Islam, Injamam Ull Haque, Alain Roman, Lionel Haentjens, Višnja Ikic, Slavica Kvolik, Robert Bojčić, Kazimir Juričić, Martin Duksa, Lukáš Bílek, Igor Satinsky, Jan Zatloukal, Lene Russell, Morten H. Bestle, Christian S. Meyhoff, Ana Maria Diaz-Medina, Verónica Llumiquinga, Hernán Aguirre-Bermeo, Heinert Enmanuel Gonzabay-Campos, Mohamed Elbahnasawy, Xavier Chapalain, Charlène Le Moal, Pierre-Yves Egreteau, Yoann Launey, Florian Reizine, Florence Boissier, Reignier Jean, Stephan Ehrmann, Eddy Lebas, Gaelle Corno, Pauline Cailliez, Pierre Garçon, Guillaume Carteaux, Antoine Kimmoun, Danai Theodoulou, STAVROS ALOIZOS, Eleftherios Papadakis, KONSTANTINOS TSAKALIS, Giorgos Marinakis, Ioannis Georgakas, Paraskevi Tripolitsioti, Sofia Nikolakopoulou, Georgios Papathanakos, Chrysanthi Sklavou, Evangelia Tsika, Ourania Mousafiri, Athanasios Prekates, Georgia Micha, Athina Lavrentieva, Theodoros Aslanidis, Athina Palaiologou, Clementine Bostantzoglou, Evangelia Dikoudi, Silia Karaouli, Sophia Pouriki, Swapna Vijayakumaran, Darshana Rathod, VENKAT RAMAN KOLA, Deepak Jeswani, Kadarapura Nanjundaiah Gopalakrishna, Amol Hartalkar, Ata Mahmoodpoor, Marwah Abdulkhaleq, Mariachiara Ippolito, Antonella Cotoia, Marco Covotta, Filippo Sanfilippo, Ehab Ishteiwy, Hebtallah Benzarti, Ahmed Elmabri Mohammed Bouhuwaish, Alya Abdalhadi, Ahmad Buimsaedah, Eman Ali Abdulwahed, Khalil Tamoos, Eman Younes, Asma Abubakr Saleh Alkamkhe, Marwa Biala, Hajer Abdalla Mohammed Hwili, Najat Shaban Ben Hasan, Bushray Alhadi Almiqlash, Mawadda Altair, Rema Otman, Mohamed Fathi Al Gharyani, Omlez Mohammed Alkeelani, Hibah Bakeer, Azah Mukhtar Omar Affat, Husayn Aween, Aihab Benamwor, Mohamed Alsori, Najwa Abdelrahim, GHANNAM Abdelilah, Rachael Parke, Yan Chen, Jan Mehrtens, Pawel Twardowski, Ross Freebairn, Rima Song, Charles Gibson, Jonathan Chen, Richard Moore, Mary Rose Sol Cruz, Anna Wludarczyk, Łukasz Krzych, Marta Szczukocka, Marcin Kubiak, Maciej Molsa, Magdalena Wujtewicz, Agnieszka Wieczorek, Agnieszka Misiewska-Kaczur, Marek Maslicki, Dariusz Onichimowski, Jakub Mazur, Pawel Zatorski, Ana Marta Mota, Joana Fernandes, Diana Castro, Elisabete Coelho, Alexandra Paula, Teresa Guimarães, Diana Adrião, Igor Mark, Elizabeta Mušič, Tomislav Mirković, Andrej Markota, Natalija Krope, Marko Kmet, Petra Forjan, Tomaž Savli, Gerardo Aguilar, Rebeca González-Celdrán, Estefanía Martínez-González, Agustín Díaz, María José Colomina, Francisco Hidalgo, Carlos Ferrando, Raquel Ferrandis, Carolina Ferrer, Virginia Cegarra, Aurelio Gómez-Luque, Stina Henman, Disa Blomstrand, Emelie Risberg, Natalie Johansen, Henrik Rajala, Natalie Layous, Eline A. Vlot, Michiel Erkamp, Nicole Juffermans, Stefan van Wonderen, Lidija Kuznecova-Keppel Hesselink, Victor van Bochove, Murat Acarel, Evren Senturk, Mahmut Alp Karahan, Aynur Camkiran Firat, Yahya Yildiz, Osman Ekinci, Asu Ozgultekin, Huseyin Arikan, Gamze Kucukosman, Bengu Gulhan Aydin, Mehmet Yavuz, Alev Oztas, Nilgun Kavrut Ozturk, Umut Sabri Kasapoglu, Hakan Miniksar, Eylem Tuncay, Cenk Indelen, Halide Ogus, Basar Erdivanli, Ayca Sultan Sahin, Mehmet Yilmaz, Erken Sayan, Canan Yilmaz, Senay Goksu, Betul Basaran, Emine Kutahya, Ayfer Kaya Gok, Ayse Ozcan, Iskender Kara, Seyfi Kartal, Kemal Tolga Saracoglu, Yeliz Bilir, Selin Eyupoglu, Nigar Ertugrul Oruc, Kubilay Issever, Jamie Patel, Jayson Clarke, Louise Ma, Tom Lawton, Brendan Sloan, Santhana Kannan, Richard Innes, Mark Carpenter, Luke Newey, Hazem Alwagih, Chris Acott, Anil Hormis, James Herdman, Osama Akrama, Rachel Baumber, Olena Khomenko, Akram Khan, Zubair Hasan, Jay S. Raval, Lauren Sutherland
Journal: JAMA (2023)

Importance Red blood cell (RBC) transfusion is common among patients admitted to the intensive care unit (ICU). Despite multiple randomized clinical trials of hemoglobin (Hb) thresholds for transfusion, little is known about how these thresholds are incorporated into current practice. Objective To evaluate and describe ICU RBC transfusion practices worldwide. Design, Setting, and Participants International, prospective, cohort study that involved 3643 adult patients from 233 ICUs in 30 countries on 6 continents from March 2019 to October 2022 with data collection in prespecified weeks. Exposure ICU stay. Main Outcomes and Measures The primary outcome was the occurrence of RBC transfusion during ICU stay. Additional outcomes included the indication(s) for RBC transfusion (consisting of clinical reasons and physiological triggers), the stated Hb threshold and actual measured Hb values before and after an RBC transfusion, and the number of units transfused. Results Among 3908 potentially eligible patients, 3643 were included across 233 ICUs (median of 11 patients per ICU [IQR, 5-20]) in 30 countries on 6 continents. Among the participants, the mean (SD) age was 61 (16) years, 62% were male (2267/3643), and the median Sequential Organ Failure Assessment score was 3.2 (IQR, 1.5-6.0). A total of 894 patients (25%) received 1 or more RBC transfusions during their ICU stay, with a median total of 2 units per patient (IQR, 1-4). The proportion of patients who received a transfusion ranged from 0% to 100% across centers, from 0% to 80% across countries, and from 19% to 45% across continents. Among the patients who received a transfusion, a total of 1727 RBC transfusions were administered, wherein the most common clinical indications were low Hb value (n = 1412 [81.8%]; mean [SD] lowest Hb before transfusion, 7.4 [1.2] g/dL), active bleeding (n = 479; 27.7%), and hemodynamic instability (n = 406 [23.5%]). Among the events with a stated physiological trigger, the most frequently stated triggers were hypotension (n = 728 [42.2%]), tachycardia (n = 474 [27.4%]), and increased lactate levels (n = 308 [17.8%]). The median lowest Hb level on days with an RBC transfusion ranged from 5.2 g/dL to 13.1 g/dL across centers, from 5.3 g/dL to 9.1 g/dL across countries, and from 7.2 g/dL to 8.7 g/dL across continents. Approximately 84% of ICUs administered transfusions to patients at a median Hb level greater than 7 g/dL. Conclusions and Relevance RBC transfusion was common in patients admitted to ICUs worldwide between 2019 and 2022, with high variability across centers in transfusion practices.